Independent assessment and
review of compliance with
CQC essential standards and outcomes
Sussex Health Care
Rapkyns Nursing Home
Guildford Road
Broadbridge Heath
Horsham
West Sussex RH12 3PQ
Date of assessment: 28 October 2013
Time: 10.05am to 6.05pm
Assessment carried out by:
Gerry Kennedy MSc BSc DipN RGN RMN
Healthcare Regulation Solutions
The findings, observations and recommendations within this
independent report should not be interpreted as consistent or in any
way representative with the findings of a Care Quality Commission
review of compliance.
PRIVATE AND CONFIDENTIAL
Independent assessment and review of compliance
with CQC essential standards and outcomes.
Introduction
This report offers an independent assessment of the care services on offer at
Rapkyns Nursing Home.
Rapkyns Nursing Home is a care home registered with the Care Quality
Commission (CQC) providing nursing and personal care to a maximum of 50
people. The home specialises in caring for people who have neurological
health conditions, mainly Huntington’s Disease. At the time of the
assessment, 33 people were living in the nursing home.
The home is set out in a two storey, detached country house style property.
All of the bedrooms are single and some rooms have en suite facilities. There
are communal lounges, a conservatory and a dining room. People's meals are
prepared and cooked on site. Any person who has a special dietary
preference is catered for.
Chris Trott is the home manager and at the time of assessment, had
submitted a formal application to the CQC to become the registered manager
responsible for the day-to-day running of the nursing home.
The category of registration is care home with nursing. Rapkyns Nursing
Home provides regulated activities of:
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accommodation for persons who require nursing or personal care
treatment of disease, disorder or injury, and
diagnostic and screening procedures.
The nursing home is located off the A281 and A29 near the village of
Broadbridge Heath, approximately three miles from Horsham, West Sussex.
Car parking facilities are available on site. The nursing home service is
provided by registered nurses and care assistants supported by:
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activities staff
administration staff
hairdresser
catering staff
domestic staff, and
general practitioners.
Extensive in-house training is provided to newly appointed staff and existing
staff by Sussex Health Care’s own dedicated staff trainers who cover all of its
care homes.
In this independent assessment, evidence was gathered from different
sources which included:
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people's healthcare records and care plans
medication records
Rapkyns Nursing Home – Independent assessment 28 October 2013
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staff recruitment records
local policies and procedures
monitoring records, and
observation of the nursing home environment.
Discussions took place with some members of staff including:
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the home manager
the area manager
two registered nurses
a member of administration staff
one healthcare assistant, and
two people who use the service.
The following areas of the nursing home premises were viewed:
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the reception and arrival area
the communal lounges
the conservatory
the dining room
the corridor areas
sluice rooms
bathrooms, and
shower rooms.
During the assessment, the current essential standards of quality and safety
of the Health and Social Care Act 2008 (Regulated Activities)
Regulations2010 were taken into consideration. Not all essential standards
were assessed.
Overall, there was evidence that Rapkyns Nursing Home:
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had addressed many of the issues identified for improvement at the
previous independent assessments carried out on 25 July 2012, 29
January 2013 and 19 February 2013 respectively
had developed individual hospital passports in order to share people's
health and social care information with other care providers
had completed mental capacity assessments and held best interest
meetings for relevant people living in the nursing home
had provided mental capacity training to staff
has improved the completion and review of DNACPR forms in relation to
people who are not to be resuscitated
treats people who use the service with respect and dignity, and
provides individualised care and support to people who use the service.
Some improvements should be considered in terms of:
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prioritising the repairs and maintenance required in different parts of the
nursing home premises
ensuring that all healthcare records including risk assessments and care
plans are completed in full, and
Rapkyns Nursing Home – Independent assessment 28 October 2013
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ensuring that medication administered to people who live in the nursing
home is consistently documented.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Essential standards and outcomes (1 – 28)
Summary recommendations
1. Damage to wall, door and skirting board surfaces should be identified and
repaired as soon as is practical. Surface impact damage can hinder
effective environmental cleaning and impact dents can become a reservoir
for dust, dirt and debris.
2. Extra attention is required in the cleaning of tile grouting, seals, and harder
to reach areas such as edges and corners.
3. MAR chart entries require to be completed in relation to each person's
prescribed medicine. Any medicines not administered should have a
written reason entered on the MAR chart. No blank areas should be left.
4. Drug fridge temperature recording should include minimum, maximum and
actual temperatures each day. This is to ensure that the fridge is operating
correctly and drugs requiring cold storage kept at the optimum
temperature.
5. Staff recruitment and selection procedures should be followed according to
policy. All of the necessary pre and post-employment information should
be obtained and held on file for each member of staff. This should be
consistent across all staff files.
6. Written confirmation of staff induction for new members of staff should be
kept on file for each member of staff.
7. All areas in all sections of the healthcare records, including admission
details, care plans and risk assessments should be completed in full. If any
areas or sections do not apply, then the words ‘Not applicable’ should be
entered to confirm that the topic had been considered.
8. All written entries in healthcare records should be dated and timed
accurately.
9. Care documentation which is designed to include involvement with a
person's relatives should be completed in full. Where there is little or no
involvement of relatives in aspects of care, written confirmation that
contact or attempted contact has been made should be recorded.
10. Where care documentation includes the involvement of different
healthcare staff, all parts of the care documentation should be completed
and signed or a reason entered as to why this may not be applicable.
11. If a person is assessed at risk following the carrying out of a risk
assessment e.g. Waterlow, a corresponding care plan should be
development in order to set out the measures to reduce the risk.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Outcome 1:
Respecting and involving people who use services
Observations
Rapkyns Nursing Home cares for people with neurological conditions and the
majority of the people living in the nursing home suffer from Huntington's
Disease. Most of the people are not fully able to express their views because
of their health condition. Two people who had limited communication were
able to speak in part, about what it is like to live at Rapkyns Nursing Home.
Both people spoke positively and said:
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‘The staff help me’
‘They do everything for me'
‘I like the food'
'My sister visits me every month'
'I am happy with my room'
During the assessment, people were observed in different parts of the nursing
home; in the lounges, the dining room, in the corridor areas and in their
bedrooms. Some people were sitting quietly, some engaged in conversation
with care staff, others watching television, and others walking around in
different parts of the nursing home. Some people chose to spend their time in
their bedrooms watching television or to be on their own. Care staff appeared
knowledgeable and familiar with people's individual preferences.
Care staff were observed engaging with people at different times of the day.
People were being treated respectfully by staff. Many people had difficulty
communicating, something that is a feature of the majority of people living in
the nursing home with a neurological condition. In each of two care plans
viewed during the assessment, there was a good description of people's
personal likes and dislikes and how to communicate with each person at their
level of understanding. Care staff were observed taking their time whilst
speaking to people who live in the nursing home. Conversations were polite
and respectful.
Some people were observed walking unsteadily which is also a symptom of
some neurological conditions. People who were walking unsteadily appeared
at times to be at risk of injury because of the potential to bump into other
people or furnishings in the nursing home. However, on further observation,
some people were being allowed to walk to maintain their independence
within the limitations of their illness. Care staff appeared aware of which
people who required additional support or supervision, than others.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Areas for improvement
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Continue to maintain this level of service and consider different ways to
involve and participate with people who have different levels of
communication difficulties at Rapkyns Nursing Home.
Overall
Rapkyns Nursing Home appears to have satisfactory arrangements and
procedures in place to respect the privacy, dignity, independence and choice
of people who use the service within the individual limitations of each person’s
health condition.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Outcome 2:
Consent to care and treatment
Observations
Many people living in Rapkyns Nursing Home are able to choose what to do
and how to spend their time each day. Others do not have capacity due to
their health condition.
Two Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) healthcare
records were viewed during the assessment. There was evidence that each
person had been assessed in terms of their understanding. Both DNACPR
forms had been completed, signed and dated by a general practitioner (GP).
Within both forms, there was evidence that each person's family had been
involved in the decision taken not to resuscitate. There was evidence that the
initial DNACPR decisions were being reviewed by the nursing home's GP and
recorded each month.
Two other people's healthcare records viewed during the assessment had
completed and signed consent forms in place to allow photographs to be
taken for clinical purposes.
Areas for improvement
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Continue to support people, when they are able, and their relatives, to
choose how they wish to be cared for and the support they receive in the
nursing home.
Overall
Rapkyns Nursing Home appears to have suitable arrangements in place to
recognise, respect and act appropriately with the consent and agreement of
people who use the service.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Outcome 3:
Fees
Observations
Not assessed on 28 October 2013.
Areas for improvement
Not applicable.
Overall
Not applicable.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Outcome 4:
Care and welfare of people who use services
Observations
The people who live at Rapkyns Nursing Home have comprehensive health
and social care assessments carried out by care staff. These assessments
are completed by registered nurses, physiotherapists, activities staff and GPs.
Physical, mental and social needs are taken into account when each person is
assessed. An activities of daily living assessment model is used.
Before being accepted to live in the nursing home, people have a preadmission assessment carried out by a member of nursing staff or the home
manager, who visits each person before a final decision is taken to accept
them. These completed pre-admission assessments are then kept in the
person's health records.
People’s likes and dislikes are taken into consideration by the care staff when
individualised care and support is being planned. Where appropriate, people’s
relatives and family members are consulted and involved, especially where a
person does not have the full ability to express their preferences.
Two people’s healthcare records and care plans were viewed during the
assessment. Both records set out clearly the care and treatment that was
being planned and provided. All care plans were written in a person-centred
way, had specific risk assessments and protocols completed in relation to
aspects of care and treatment, and showed evidence of regular review. Some
documents in the health records had spaces for relatives’ signatures.
However, some of these were observed to be blank with no reason provided
as to why a relative was not involved.(More extensive assessment of health
records is described at Outcome 21 of this assessment report.)
Areas for improvement
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Care documentation which is designed to include involvement with a
person's relatives should be completed in full. Where there is little or no
involvement of relatives in aspects of care, written confirmation that
contact or attempted contact has been made should be recorded.
Overall
Rapkyns Nursing Home appears to have satisfactory arrangements and
procedures in place to ensure that people receive safe and appropriate
treatment and care that meets their health and social care needs.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Outcome 5:
Meeting nutritional needs
Observations
During the assessment, many people ate their lunch in the dining room.
People using the dining room were not directly observed eating in order to
allow them privacy to eat their meals with the assistance and support from
familiar care staff.
Preparation of the dining room was observed and dining tables had individual
table covers and cutlery in place. Each place setting had a place mat. Small
sets of flowers were on each table. The menu was on display for the
autumn/winter period with a description of each dish and whether it was
suitable for a soft or liquidised option. Pictorial menus were available with
large pictures of plated food to offer an indication what each dish may look like
when served.
Two people's health records were viewed during the assessment. In one
record there was evidence that a risk assessment had been carried out on the
person's ability to chew and swallow safely. This was being reviewed each
month.
In the other person's health record there was evidence that a risk assessment
had been carried out in relation to the person's difficulty in eating and
swallowing.
There was written evidence that food menu meetings had taken place
between many of the people who live in the nursing home, kitchen staff, and
care staff. The most recent menu meeting was held on 18 March 2013 where
nine people and four staff attended. Topics that were discussed included
vegetarian food options, different types of food for the summer menu,
seasoning of the food, and the availability of fresh fruit. People were being
directly asked about their food preferences during the meetings and how they
felt about the food.
People have nutritional assessments carried out by care staff. Rapkyns
Nursing Home has access to a qualified Dietician if there is a concern with a
person’s nutritional state or if someone is identified at risk as a result of a
nutritional assessment.
Areas for improvement
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Continue to maintain this level of dietary support for people who use the
service at Rapkyns Nursing Home.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Overall
Rapkyns Nursing Home appears to have satisfactory arrangements in place to
provide adequate nutrition, hydration and support to people who use the
nursing home service.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Outcome 6:
Co-operating with other providers
Observations
Each person who lives at Rapkyns Nursing Home has a hospital passport
document in place. The passport contains individual personal health and
social care information about likes and dislikes, personal wishes about care,
and ability for self care. A copy of the hospital passport is used if a person
requires to be admitted to hospital, or to attend an outpatient appointment.
The passport is provided to the hospital to ensure that the receiving hospital
staff have up to date health and social care information about the person.
Two people's health records were viewed during the assessment. Both
records contained a fully completed hospital passport document, which
included a completed mental capacity assessment.
One member of nursing staff was spoken to during the assessment and
explained clearly about how the passport document is used to share
information with other health and social care providers if a person is
transferred out of the nursing home.
Areas for improvement
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Ensure that each person's hospital passport document is kept up to date at
all times.
Overall
Rapkyns Nursing Home has arrangements in place to share health and social
care information with other providers.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Outcome 7:
Safeguarding people who use services from abuse
Observations
Safeguarding training is provided for all members of staff at Rapkyns Nursing
Home as part of Sussex Health Care's mandatory staff training programme.
Two members of staff were asked if they had attended safeguarding training
and replied that they had. Staff appeared knowledgeable about the issue of
safeguarding and what to do in the event of a potential safeguarding issue
arising.
Areas for improvement
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Maintain this level of safeguarding training for all staff working at Rapkyns
Nursing Home.
Overall
Rapkyns Nursing Home has suitable arrangements in place to protect people
who use the service from abuse. This includes the provision of safeguarding
training for all staff.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Outcome 8:
Cleanliness and infection control
Observations
Rapkyns Nursing Home is an older property consisting of 50 bedrooms. All of
the bedrooms are single and some rooms have en suite toilet and bath
facilities. The rooms without en suite facilities have a wash hand basin only.
The nursing home was previously assessed on 25 July 2012. During that
assessment, a random sample of accommodation areas of the nursing home
premises was viewed. It was observed that several bedroom areas were tired
in appearance and in need of some repair and maintenance. Some
redecoration was required as peeling and torn wallpaper, scuffed and chipped
surfaces on door edges and skirting boards were observed.
During this assessment, similar areas were viewed. Many of the observations
noted in the assessment of 25 July 2012 were still applicable in terms of the
repairs, maintenance and redecoration required. However, it was observed
that the linen store cupboards were much tidier compared to the previous
assessment.
The following observations are set out in comparison to the previous
assessment:
GROUND FLOOR
Bathroom (next to bedroom 32)
Some areas of silicone sealant appeared discoloured.
Linen Cupboard (next to bedroom 33)
The cupboard was tidy in appearance. All items were being stored tidily on
shelving.
Bathroom (opposite bedroom 29)
A nurse call handset was sitting on the window ledge wrapped in cling film; it
was unclear what was to happen to this handset. Some insects and cobwebs
were visible at some of the higher levels.
Shower Room (next to the dining room)
A wall cupboard contained different items including incontinence products,
gloves, plastic bags and some clothing. The cupboard appeared untidy and
unorganised. Some repairs had been carried out at the base of the WC at the
tiled floor.
FIRST FLOOR
Laundry Store (next to bedroom 8)
The cupboard was tidy in appearance. All items were being stored tidily on
shelving.
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Outside Bedroom 15
A section of vertical carpeting was separating/coming away from the wall.
Bedroom 15
Parts of the door edges and facings were chipped. The wall area under the
window surface was marked and some of the wallpaper torn.
Linen Cupboard (outside bedroom 47)
The cupboard was tidy in appearance. All items were being stored tidily on
shelving.
Bathroom (next to bedroom 46)
Some silicone edges appeared unclean and discoloured. The underside of the
clinical waste bin appeared unclean.
Bathroom (next to bedroom 39)
Some of the silicone sealant was separating from the bath and bath panel.
Some items including a facecloth, shampoo and sponge were left lying on a
work surface. It was unclear if these items were for one person's use.
Areas for improvement
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Damage to wall, door and skirting board surfaces should be identified and
repaired as soon as is practical. Surface impact damage can hinder
effective environmental cleaning and impact dents can become a reservoir
for dust, dirt and debris.
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Extra attention is required in the cleaning of tile grouting, seals, and harder
to reach areas such as edges and corners.
Overall
Rapkyns Nursing Home is an older property and some internal areas are tired
in appearance and in need of repair, redecoration and refurbishment. It is
challenging to maintain cleanliness in a care environment that needs to be
refurbished.
Rapkyns Nursing Home should review its infection control arrangements
throughout the care home premises. This is to ensure that all necessary
measures are taken to reduce and minimise risks of developing infection and
to maintain a clean and safe care environment.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Outcome 9:
Medicines management
Observations
Medicines are stored securely in a dedicated medicines room. Medicines are
provided using a monitored dosage system (MDS) provided by an external
pharmacy supplier. When medicines are administered, an entry is recorded in
a person's medicines administration record (MAR) chart by a member of
nursing staff.
Several MAR charts were viewed during the assessment. There was evidence
of a small number of unexplained gaps in the MAR chart of one person's
records. Two individual medicines had not been signed as being administered
on one particular date. It was unclear if the medicines had been given to the
person and had not been signed for by the administering nurse, or were not
required to be given for some reason.
A homely remedies list of seven items of medication had been agreed. This
list of medication had been authorised and signed by the GP to allow nursing
staff to administer the medicines to people without a prescription. Full records
were in place confirming which home medicines had been administered.
In the medicines room, a drug fridge is used to store medicines that require
cold storage. Actual fridge temperatures are being recorded each day. From
the records seen, the drug fridge was being maintained at an optimum
temperature. However, at the date of assessment, the temperature of the
fridge had not been recorded since 22 October 2013. In addition, minimum
and maximum temperatures were not being recorded.
Areas for improvement
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MAR chart entries require to be completed in relation to each person's
prescribed medicine. Any medicines not administered should have a
written reason entered on the MAR chart. No blank areas should be left.
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Drug fridge temperature recording should include minimum, maximum and
actual temperatures each day. This is to ensure that the fridge is operating
correctly and drugs requiring cold storage kept at the optimum
temperature.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Overall
Rapkyns Nursing Home has the necessary arrangements in place to ensure
medicines are stored securely and people receive their medicines safely and
correctly. Some minor improvements are required.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Outcome 10:
Safety and suitability of premises
Observations
Rapkyns Nursing Home provides nursing and personal care, support and
accommodation for up to 50 people. The nursing home is a large country
house style property set out over ground and first floors and is suitable for
access by wheelchair users and less able people. A lift elevator is available.
At the time of the inspection, all communal internal areas of the premises
appeared clean and well lit. However, the premises is an older property and
some internal areas appeared tired and in need of repair and redecoration.
Wall and floor surfaces in some areas of the nursing home were observed to
have some areas of impact damage. Wall surfaces in some people's
bedrooms had torn wallpaper. Surface impact damage can hinder effective
environmental cleaning and impact dents and scratches can become a
reservoir for dust, dirt and debris. Such areas require repair to ensure intact
surfaces are maintained and to facilitate ease of cleaning. (see further
assessment at Outcome 8 – Cleanliness and infection control.)
Areas for improvement
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Damage to wall, door and skirting board surfaces should be identified and
repaired as soon as is practical. Surface impact damage can hinder
effective environmental cleaning and impact dents can become a reservoir
for dust, dirt and debris.
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Consideration should be given to the current care environment in terms of
the repairs, maintenance and refurbishment that are required in different
areas.
Overall
Rapkyns Nursing Home should review its maintenance, repair, refurbishment
and redecoration arrangements. This is to ensure that the care environment is
suitable to accommodate the needs of people who live in the nursing home.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Outcome 11:
Safety, availability and suitability of equipment
Observations
Not assessed on 28 October 2013.
Areas for improvement
Not applicable.
Overall
Not applicable.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Outcome 12:
Requirements relating to workers
Observations
Staff personnel files are stored securely in the nursing home in the Home
Manager’s office.
Five staff files were viewed during the assessment. Each staff file was set out
well using a helpful index at the start of each file allowing individual items of
information to be easily found. The following items of recruitment information
were observed to be in place in each file:
Staff File 1 (Healthcare Assistant)
Recruitment checklist
Photo identification
Application form
Record of interview
Reference x 1 (Reference only confirms employment in previous position.
Does not comment on ability.)
Criminal record check
Confirmation of appointment letter
Terms and conditions
Job description
Induction training
Staff File 2 (Healthcare Assistant)
Recruitment checklist
Photo identification
Application form
Record of interview
References x 2
Criminal record check
Terms and conditions
Job description
Not seen in this file
Evidence of induction training.
Letter of appointment.
Staff File 3 (Registered Nurse)
Recruitment checklist
Photo identification
Application form
Record of interview
References 2
Criminal record check
Confirmation of appointment letter
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Terms and conditions
Job description
Induction training
NMC PIN check
Staff File 4 (Healthcare Assistant)
Recruitment checklist
Photo identification
Application form
Record of interview
References x 2
Criminal record check
Confirmation of appointment letter
Job description
Induction training
Not seen in this file
Terms and conditions
Staff File 5 (Healthcare Assistant)
Recruitment checklist
Photo identification
Application form
Record of interview
References x 2
Criminal record check
Confirmation of appointment letter
Terms and conditions
Job description
Not seen in this file
Evidence of induction training.
Areas for improvement
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Staff recruitment and selection procedures should be followed according to
policy. All of the necessary pre and post-employment information should
be obtained and held on file for each member of staff. This should be
consistent across all staff files.
Overall
The majority of the staff recruitment information seen within the five staff files
viewed was satisfactory. The expected pre-employment information was in
place in each staff file. Some minor improvements are needed to ensure
consistency of the information held on file.
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Outcome 13:
Staffing
Observations
The staffing in the nursing home is determined according to the number of
people living there at any time along with individual levels of care and support
required. The staffing skill mix includes:
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Home Manager (Registered Nurse)
Staff Nurses
Care Assistants
Activities Co-ordinator
Administrator
Maintenance staff
Catering staff, and
Domestic staff.
When the staff off-duty is being planned, an equal mix of staff skills,
qualifications and experience is set out each week to ensure that people's
health and social care needs are being met.
During the assessment, care staff were observed in different areas of the
nursing home premises. There were no observations of any areas left
unattended by staff where people were present.
Areas for improvement
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Maintain an appropriate level and skill mix of staff to meet the nursing care
needs of people who use the service.
Overall
At the date of assessment, Rapkyns Nursing Home appears to have sufficient
numbers of staff with the appropriate experience and qualifications to support
and care for people who use the service.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Outcome 14:
Supporting workers
Observations
Five staff files were viewed during the assessment. In two of the staff files,
there was no evidence that induction training had taken place on
commencement of employment.
Regular staff meetings were being held. There was evidence that the most
recent staff meeting was held on 12 August 2013 and 21 members of staff
had attended. Topics discussed at the meeting included records, covering the
off duty rota, reporting of accidents and incidents, complaints, updating staff
files, not being disturbed during medicine rounds, signing out, and
sickness/absence.
There was also evidence of previous staff meetings having been held in the
months of June, May, April, February and January 2013.
Areas for improvement
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Written confirmation of staff induction for new members of staff should be
kept on file for each member of staff.
Overall
Rapkyns Nursing Home has the necessary arrangements in place to provide
training to care staff. This includes the recording of staff attendance at each
training and learning event. Staff performance should be monitored through
appraisal and confirmation records kept on file.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Outcome 15:
Statement of purpose
Observations
Not assessed on 28 October 2013.
Areas for improvement
Not applicable.
Overall
Not applicable.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Outcome 16:
Assessing and monitoring the quality of service provision
Observations
Regular monitoring visits are carried out by the Sussex Health Care area
manager responsible for Rapkyns Nursing Home. Records confirmed that the
most recent monitoring visit was in August 2013. Areas that were assessed
included people's care plans, meal choices, activities, cleanliness of the
environment, and speaking with residents and staff.
Areas for improvement
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Continue to assess and monitor the service and consider other areas to
audit e.g. care plan records and record keeping, medicines administration
and completion of MAR charts, accidents/incidents, and infection control.
Overall
Rapkyns Nursing Home has arrangements in place to assess and monitor the
service provided.
Rapkyns Nursing Home – Independent assessment 28 October 2013
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Outcome 17:
Complaints
Observations
A complaints procedure is in place to support and advise anyone who feels
that they wish to make a complaint. Details of how to contact the Care Quality
Commission are included in the procedure.
Areas for improvement
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None.
Overall
Rapkyns Nursing Home has the necessary arrangements and procedures in
place to deal with complaints from people who use the service.
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Outcome 18:
Notification of death of a person who uses services
Observations
Rapkyns Nursing Home is aware of the procedures to take in notifying the
Care Quality Commission (CQC) when a person has died.
Areas for improvement

None.
Overall
Rapkyns Nursing Home has the necessary information in place to inform the
Care Quality Commission about the death of any person who uses the care
home service.
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Outcome 19:
Notification of death or unauthorised absence of a person who is
detained or liable to be detained under the Mental Health Act 1983
Observations
Not assessed on 28 October 2013.
Areas for improvement
Not applicable.
Overall
Not applicable.
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Outcome 20:
Notification of other incidents
Observations
The home manager at Rapkyns Nursing Home is aware of the procedure to
notify the Care Quality Commission about events relating to peoples’ health,
safety and welfare.
Areas for improvement

None.
Overall
Rapkyns Nursing Home has the necessary information in place to inform the
Care Quality Commission about relevant events and incidents that may affect
a person’s health, safety and welfare whilst using the care home service.
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Outcome 21:
Records
Observations
Care plan documentation
Two people's healthcare records were assessed during the assessment.
In both care records, the majority of sections of the healthcare records were
completed to the expected standard. Most of the written entries were dated,
timed, clearly written and signed by the member of staff making the entry.
There was evidence of regular reviews of people’s health and wellbeing taking
place in all records assessed.
The following specific observations were noted:
Healthcare record 1
A hospital passport document was in place in the person's records. This
document had comprehensive details written about the person's abilities in
communicating, eating and drinking, level of pain, medication, sight and
hearing, behaviour, safety, using the toilet, personal care required, moving
around, sleeping, and likes and dislikes. The passport was designed in a way
that could be readily shared with other health and social care providers in the
event that the person might be admitted to hospital or attend for an outpatient
appointment.
A mental capacity assessment had been carried out and completed by a
medical practitioner. The assessment confirmed that the person did not have
capacity.
Consent had been obtained to take photographs for clinical reasons.
Staff signatures were in place to confirm staff awareness of this person’s care
plan and content. This had been signed by 24 members of staff.
Care plans had been developed in areas which include: communication, likes
and dislikes, personal hygiene, and nutrition. There was evidence that the
care plans were being reviewed but dates of review were not fully recorded in
that only the month was being written e.g. 'October'.
In the person's progress and evaluation records all of the written entries were
observed to be dated, signed and legible. The majority of the written entries
were timed accurately. However a small number of entries were timed as
'nocte' and 'day' and therefore did not confirm an accurate time of writing the
entry.
A protocol in relation to the person's personal hygiene had been developed.
This had been signed by the care manager, named nurse and the person's
relative who had been involved.
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Several risk assessments had been completed. A risk assessment on the
person's ability to chew and swallow was in place. There was evidence that
this assessment was being reviewed on a monthly basis. This had been
signed by the person's key worker, home manager, and physiotherapist.
However, the assessment record had spaces for the resident, their relative
and care manager to sign but these were blank and no reason had been
given for the absence of signatures.
The Waterlow Pressure Ulcer Risk Assessment had been used to assess skin
integrity and there was evidence of monthly review. The person scored 14 as
a result of the Waterlow assessment which suggested that they were at risk of
developing a pressure ulcer. However, there was no corresponding care plan
in place in terms of how this risk was to be reduced and managed.
Other risk assessments carried out included the topic of mobility which had
been signed by the person's key worker and home manager only.
A risk assessment on the subject of challenging behaviour was in place but
this had not been reviewed since July 2013. It was unclear if this risk
assessment was still applicable to the person.
Healthcare record 2
A pre-admission assessment had been completed.
A hospital passport document was in place in the person's records and
contained comprehensive information about the person's health and social
care abilities in terms of the level of care and support required. The passport
was designed in a way that could be readily shared with other health and
social care providers in the event that the person might be admitted to hospital
or attend for an outpatient appointment.
A mental capacity assessment had been carried out and completed by a
medical practitioner. The assessment confirmed that the person did not have
capacity. A care plan had been developed in relation to the person's mental
well being and included mention and cross reference to the mental capacity
assessment.
Specific care plans had been developed in subject areas which included
communication, mobility, sleeping, and safe environment. There was evidence
that the care plans were being reviewed but some of the care plan documents
had not been signed by a registered nurse.
Several risk assessments had been completed in relation to fall and injury,
difficulty in eating, neurological symptoms, and swallowing difficulties. Each
risk assessment had been signed by the person's key worker only. However,
the assessment record had spaces for the resident, their relative, day care
representative and physiotherapist to sign but these were blank and no
reason had been given for absence of signatures.
Consent had been obtained to take photographs for clinical reasons. The
consent form confirmed that the person was unable to sign due to their health
condition.
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DNACPR Records
A further two people's records were viewed in relation to the completion of
DNACPR documentation.
Healthcare records 3 and 4
In both records, the DNACPR forms were fully completed by a medical
practitioner, there was evidence of involvement and consultation with people's
relatives in the decisions taken not to resuscitate. There was also evidence
that the decisions taken not to resuscitate were being reviewed on a monthly
basis by the nursing home general practitioner. A copy of the DNACPR form
was included in the hospital passport document.
Areas for improvement

All areas in all sections of the healthcare records, including admission
details, care plans and risk assessments should be completed in full. If any
areas or sections do not apply, then the words ‘Not applicable’ should be
entered to confirm that the topic had been considered.

All written entries in healthcare records should be dated and timed
accurately.

Care documentation which is designed to include involvement with a
person's relatives should be completed in full. Where there is little or no
involvement of relatives in aspects of care, written confirmation that
contact or attempted contact has been made should be recorded.

Where care documentation includes the involvement of different
healthcare staff, all parts of the care documentation should be completed
and signed or a reason entered as to why this may not be applicable.

If a person is assessed at risk following the carrying out of a risk
assessment e.g. Waterlow, a corresponding care plan should be
development in order to set out the measures to reduce the risk.
Overall
The health records viewed during the assessment conveyed a positive person
centred approach to formulating an individual plan of care. Rapkyns Nursing
Home should continue to review all people's care plan documentation to
ensure that all areas of risk assessments, care protocols, planned care, care
interventions and support are completed in full and up to date to reflect each
person’s health and well being needs.
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Outcome 22:
Requirements where the service provider is an individual or partnership
Observations
Not assessed on 28 October 2013.
Areas for improvement
Not applicable.
Overall
Not applicable.
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Outcome 23:
Requirement where the service is a body other than a partnership
Observations
Not assessed on 28 October 2013.
Areas for improvement
Not applicable.
Overall
Not applicable.
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Outcome 24:
Requirements relating to registered managers
Observations
Chris Trott is the home manager at Rapkyns Nursing Home. At the time of
assessment, Chris had submitted a formal application to the CQC to become
the registered manager responsible for the day-to-day running of the nursing
home.
Areas for improvement

The home manager should prepare for the CQC Registered Manager
application process and fit person interview.
Overall
A CQC Registered Manager requires to be formally appointed at Rapkyns
Nursing Home. Chris Trott is the registered manager applicant and should
prepare to demonstrate to the Care Quality Commission that she has the
necessary skills and experience to meet the requirements to take on the role
in managing the day to day care service at the nursing home.
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Outcome 25:
Registered person: training
Observations
Not assessed on 28 October 2013.
Areas for improvement
Not applicable.
Overall
Not applicable.
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Outcome 26:
Financial position
Observations
Sussex Health Care as an organisation has the necessary financial resources
in place to provide a nursing home service at Rapkyns Nursing Home.
Areas for improvement

Continue to maintain the necessary financial resources to provide the care
home service.
Overall
Sussex Health Care has the necessary financial arrangements in place to
provide an independent care home service as described in the Statement of
Purpose document.
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Outcome 27:
Notifications – notice of absence
Observations
Not assessed on 28 October 2013.
Areas for improvement
Not applicable.
Overall
Not applicable.
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Outcome 28:
Notifications – notice of changes
Observations
Not assessed on 28 October 2013.
Areas for improvement
Not applicable.
Overall
Not application.
Website: www.healthcare-regulation.co.uk
Telephone: 020 3535 1898 / 07969 618923
E-mail address: gerry@healthcare-regulation.co.uk
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